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Important Waiver/Variance Information & Templates
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Important Waiver/Variance Information and Templates for Assisted Living Providers

We understand you are facing a number of challenges right now and additional waivers/variances to the regulations may be helpful.  Through our conversations with the leadership at the Department of Health Services and Bureau of Assisted Living, they understand the need for regulatory flexibility and are open to reviewing waiver and variance requests.  Currently, DHS/BAL is reviewing these requests with an average 1-2 day turnaround. Access DHS/BAL Assisted Living Facility Waiver, Approval, Variance or Exception Request, F-62548

Information about how to submit a waiver/variance can be found here


Please remember that these templates are provided as guidance.  You need to complete each document with your own facility-specific information prior to submitting the form with particular attention to the section entitled "Steps Facility Will Implement to Ensure Resident Safety."  Further, please confirm you are requesting a variance for your license category and using a template that corresponds to your facility type (AFH or CBRF). 


Adult Family Homes DHS 88:


DHS 88.04(2)(g) Screening for Illness


DHS 88.06(2)(a) Screening for Communicable Disease


DHS 88.07(1)(e) Use of Remote Support for Regulated Adult Family Home

  • WALA recommends when utilizing this Variance Template, to reference the DQA Memo 20-006 / Use of Remote Support Providers in Regulated Adult Family Homes. You may access this memo here


Community Based Residential Facilities CBRF DHS 83:


DHS 83.23 Employee Supervision


DHS 83.28(4) Resident Health Screening


DHS 83.28(5) and 83.35(2) Temporary ISP


DHS 83.29(2)(h) Admission Agreement Notice of Transfer


DHS 83.17(2)(a) Screening for Communicable Disease 


DHS 83.22 Employee Task-Specific Training



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